Move Prescriptions Online Now

By Ronald L. Scott
Rscott@central.uh.edu

Within the last several weeks, news sources reported the following:

In the Texas case, the jury attributed the death of Ramon Vasquez to the illegibility of a prescription. A pharmacist dispensed 20mg Plendil, a drug used to control high blood pressure, rather than Isordil, used to control angina. The maximum daily dosage of Plendil is 10mg, so the patient not only received the wrong medication, but also took an overdose. One day after taking the medication, the patient suffered a heart attack, and he died a few days later. Jurors held both the pharmacy and physician liable for the medication error. The error could have been prevented if the prescription had been typed, or transmitted electronically from the physician to the pharmacy. The physician’s attorney, Max E. Wright, said, "This jury clearly questioned why in the electronic age…we’re still using this antiquated system based on a 3 ½ -by-5 [inch] piece of paper."

A recent report by the National Academy of Sciences found a variety of medication errors are not uncommon, including those involving drug interactions, nomenclature such as incorrect drug name, dosage form, or abbreviations. The report found that medication errors are often preventable, and that "computerized drug order entry systems have much potential to reduce errors." See To Err is Human, available at http://www.nap.edu/books/0309068371/html/. President Clinton has ordered the Quality Interagency Coordination Task Force to recommend how the federal government should implement the report’s patient safety proposals.

Pharmacy benefit managers are already posting some patients’ medication records on the Internet, accessible to the patients and their physicians. The benefit managers believe that online prescription records can help ensure that physicians order the appropriate medication and are alerted to possibly dangerous drug interactions. Programs that allow physicians to access patients’ prescription histories require that physicians first obtain the consent of their patients. Serious issues of privacy, confidentiality, and potential for misuse of online prescription records remain. However, with adequate controls, the potential benefit to patients is real.

Programs such as the Digital Credentials program created by the AMA and Intel should allow pharmacies to communicate more confidently with physicians. See AMA Digital Credential FAQs at http://www.ama-assn.org/ad-com/releases/1999/digcred.htm. In any event, a simple e-mail is probably more traceable and less prone to error than the present system, where in many cases an employee in a physician’s office calls an answering machine in a pharmacy to order a prescription.

Handwritten prescriptions should be relegated to the past. Pharmacies should insist on typed prescriptions at a minimum, and encourage physicians to transmit prescriptions electronically. The physician and pharmacy will have a better record of the medication and dosage prescribed and instructions for use, chances for error (and resulting legal liability) will be reduced, and the electronic transmission will facilitate electronic access to medication records by patients and their physicians.

12/10/99